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This article provides general information about collecting and coding a [[CCI Procedure]].   
This article provides general information about collecting and coding a [[CCI Procedure]].   


They are entered in [[CCMDB.mdb]] in the [[Patient viewer tab CCI]] on the [[Patient viewer tab CCI]].
They are entered in [[CCMDB.accdb]] in the [[Patient Viewer Tab CCI_Pick]] and [[Patient Viewer Tab CCI_Comp]] on the [[Patient Viewer]].


There are some [[ICD10 Diagnoses and CCI Codes that need to be coded together]]. For background information, see [[CCI]] and [[Reasoning around moving to CCI and our subset of it]].
For background information, see [[CCI]] and [[Reasoning around moving to CCI and our subset of it]].


== Collection instructions ==
== Collection instructions ==
===Start Date: Jan 1, 2019 ===


=== Determining if the procedure you found is one we collect ===
=== Selecting and entering [[CCI]] procedure in [[CCMDB]] ===
*There are THREE subsets of procedures we '''will'' code
**Procedures done outside the unit
**Procedures done on the unit including an endoscope
**A select group of other procedures done on the unit.
 
==== (A) Procedures done outside the unit ====
Include ''all '''[[List of CCI procedures we don't code|codable]]''' procedures'' that meet the definition of one of the [[Px Type]]s that are done '''outside the patient’s unit'''.
 
==== (B) Procedures done on the unit (endoscope or non-therapeutic) ====
*This includes both diagnostic and therapeutic procedures done with an endoscope -- and that scope may be inserted through an oriface, incision or wound.
*Includes '''all of the following '''[[List of CCI procedures we don't code|codable]]''' procedures''' done on the unit:
 
=== (C) Other on-unit procedures ===
*(b) all [[List of CCI procedures we don't code|codable]] '''[[Diagnostic Procedure]]s'''
*(c) all [[List of CCI procedures we don't code|codable]] '''[[Imaging Procedure]]s'''
*(d) all [[List of CCI procedures we don't code|codable]] '''[[Obstetric Procedure]]s'''
*(d) all [[List of CCI procedures we don't code|codable]] '''[[Miscellaneous Procedure]]s'''
 
==== [[CCI Procedures coded once per ward admission]] ====
Some procedures are only coded the first time they happen. See [[CCI Procedures coded once per ward admission]].
 
=== Don't code sub-procedures that are part of a larger procedure ===
Do not code a procedure that is part of a "Bigger" procedure already coded.
'''Example:''' In the course of many or most CABG surgeries, there is placement of chest tubes, pacer wires, and vein harvest, but do NOT code those procedures separately, since they are "included" in the CABG code.
 
=== Before You Decide to NOT Code a Procedure ===
*We're not looking to code procedures that not either: (a) on the picklist, or (b) able to be constructed from it's components [e.g. a body part, and what was done to that body part].
*The main issue here is that among the lists "what was done", we haven't included EVERY possibility.
**For example, in the Imaging Procedures, besides some plain X-rays contained in that picklist, the "what type of imaging study was done" does NOT include plain x-rays.  Thus we're not enabling creation of a plain X-ray of other body part other than those contained in the picklist.
**Similarly, for the Therapeutic Procedures, there is a list of approximately 30 items of "what was done" to the chosen body part. So some items of "what was done" are not available and you won't be able to code such procedures. 
***'''BUT, before you decide this is the case, you will need to become very familiar with the descriptions of EACH of the "what was done" items that ARE available'''.  For example the item '''[[Bypass]]''' includes creating a ostomy (which includes a colostomy and even a tracheostomy).
****See '''[[CCI component 2 codes - what was done]]'''
 
=== [[Aborted Procedure]] ===
*See [[Aborted Procedure]] for how to code
 
== Selecting and entering [[CCI]] procedure in [[CCMDB]] ==
Follow these steps, in this order:  
Follow these steps, in this order:  
# for every procedure:  
# for every procedure:  
Line 51: Line 15:
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
##* pick the left column, [[CCI component 1 codes - what organ was something done to]].
##** if there are too many and you only want to see e.g. the therapeutic ones and not the imaging ones, use the [[L_CCI_Component_subform#CCI_Chooser (the "?" button)]]. In the form it opens you can filter by the [[CCI Category]].
##** if there are too many and you only want to see e.g. the therapeutic ones and not the imaging ones, use the [[L_CCI_Component_subform#CCI_Chooser (the "?" button)]]. In the form it opens you can filter by the [[CCI Category]].
##* in the column on the right, pick the [[CCI component 2 codes - what was done]].
##* in the column on the right, pick the [[CCI component 2 codes - what was done]]; the component on the right has to be of the same ''diagnostic / therapeutic / imaging'' kind as the component 1 - if you try to mix types you will get an error.  
## whether CCI picklist or CCI component,  
## whether CCI picklist or CCI component,  
### enter a [[Px_Type]] - "admit" ([[Admit Procedure]]) or "acquired" ([[Acquired Procedure]])
### enter a [[Px_Type]] - "admit" ([[Admit Procedure]]) or "acquired" ([[Acquired Procedure]])
Line 57: Line 21:
### enter a [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day
### enter a [[Px_Count]] - the number of '''separate''' times it was done''' '''''on a given day


=== Repeated procedures ===
==== productivity features ====
If a procedure is done repeatedly '''on the same day''', only enter it once but count it in [[Px_Count]].  
To reduce clicks to enter same Picklist entries for additional days, there are some extra buttons:
* "x2" will duplicate this line with the next date
** "+" and "-" will up or down the date by one day, to make the copy more useful
* [[Blue button in CCI Picklist]] will fill a range of dates
 
== Collection modes ==
<!--As discussed [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes#ICU_Database_Task_Group_Meeting_.E2.80.93_October_31.2C_2018]] -->
*We code CCI procedures in 5 different [[CCI Collection Mode]]s''':
{{:CCI collect each}}
{{:CCI collect count each}}
{{:CCI collect count days}}
{{:CCI collect count units}}
{{:CCI collect first}}
 
=== List of CCI Elements and their collection modes ===
{{Collapsable
| always= picklist
| full=
{{#ask: [[Has CCI Picklist Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
|?Has CCI Collection Mode
|format=broadtable
|link=all
|limit=1000
|class=sortable wikitable smwtable
}} }}
{{Collapsable
| always= component 2 list
| full=
{{#ask: [[Has CCI 2 Code::+]][[Has StopDate::>{{CURRENTDAY}} {{CURRENTMONTHNAME}} {{CURRENTYEAR}}]]
|?Has CCI Collection Mode
|format=broadtable
|link=all
|limit=1000
|class=sortable wikitable smwtable
}} }}
 
== Special Cases ==
=== No Procedures Performed ===
If no procedures were performed '''enter [[No procedure performed]] as an [[Admit Procedure]] with a [[Px Count]] of 1 into the [[CCI Picklist]]''', the top of the tab. Do not enter any procedrues into the CCI Component section, ie leave it as "[[No procedure entered]]". Entering this will mean at least one CCI entry is present when [[Query check CCI must have entry]] checks that entering procedures was not just forgotten.
 
=== Moved patients ===
*There are important issues/rules for admit procedure coding when a patient is being transferred from one unit/ward to another unit/ward -- and this is even more complicated if in between leaving one unit/ward and arriving on another unit/ward, the patient stops in a procedure area and gets one or more procedures.
*Here are the guidelines for these situations:
**(i) Transfer from collecting location A to collecting location B without any stop in between where procedures might occur -- all procedures done before leaving location A will be collected by location A only.
**(ii) Transfer from collecting location A to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A will be collected by location A only, while procedures done at the stop in between will be coded by location B only.
**(iii) Transfer from noncollecting location A (which includes ED) to collecting location B without any stop in between where procedures might occur -- any qualifying admit procedures done before leaving location A will be collected by location B
**(iv) Transfer from noncollecting location A (which included ED) to collecting location B WITH a stop in between where procedures occur -- all procedures done before leaving location A or during the stop in between will be coded by location B only.


Procedures done on a '''different''' day should be entered again with a different date. This should be really quick by using the "duplicate" button.
=== Procedures we don't code ===
We are not tracking all possible procedures. If a procedure can not be coded using the picklist or combined method, then we likely are not interested in coding it.  


=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
See [[List of CCI procedures we don't code]] for procedures we explicitly don't collect. If you come across a procedure you were not able to code, but think we probably should be coding, please note it [[List of CCI procedures we don't code|there]].
Some intervention are both diagnostic/imaging and therapeutic. For those situations, only code the therapeutic part.


For endoscopic inspection/explorations, code only the '''"furthest/deepest"''' area assessed.
See [[Reasoning around moving to CCI and our subset of it#Why do we not include the entire set of CCI codes]] and [[List of CCI procedures we don't code]] for more info.


Examples:
=== Don't code sub-procedures that are part of a larger procedure ===
* for a [[Coronary angiogram (diagnostic cardiac catheterization)]] where [[Coronary angioplasty with stenting]] happens in the same sitting, only code the [[Coronary angioplasty with stenting]].
*Do not code a procedure that is part of a "Bigger" procedure already coded.
* if a tissue [[Biopsy (non-endoscopic)]]/[[Biopsy (endoscopic)]] is done as part of an invasive [[Inspection, Exploration (non-endoscopic)]]/[[Inspection, Exploration (endoscopic)]] code only the [[Biopsy (non-endoscopic)]]/[[Biopsy (endoscopic)]].
'''Example:''' In the course of many or most CABG surgeries, there is placement (or replacement) of chest tubes, pacer wires, arterial lines, central lines, and vein harvest, but do NOT code those procedures separately, since they are "included" in the CABG code.
* If a CT is done on the abdomen, chest and pelvis, enter 3 entries in the component area?
*On the other hand, things done in OR that are NOT part of the standard procedure (e.g. for someone coming out from OR after CABG who now has ECMO, Swan-Ganz, IABP), you SHOULD code these as [[Admit Procedure]]).


=== We are not tracking all possible procedures ===
=== Related Imaging, Diagnostic and Therapeutic procedures performed at the same time ===
We are not tracking all possible procedures; see [[Reasoning around moving to CCI and our subset of it#Why do we not include the entire set of CCI codes]] and [[List of CCI procedures we don't code]] for more info.
*When at the same sitting both diagnostic and therapeutic procedures are done, then CODE THEM BOTH
{{ex|*  a cardiac cath is done and then a stent is placed -- code the diagnostic cath and the therapeutic stenting.
* for an [[Angiogram, coronary (diagnostic cardiac catheterization)]] where [[Angioplasty, coronary (with stenting)]] happens in the same sitting, code both}}
* if a tissue [[Biopsy (non-endoscopic)]]/[[Biopsy (endoscopic)]] is done as part of an invasive [[Inspection, Exploration (non-endoscopic)]]/[[Inspection, Exploration (endoscopic)]] code both
*When multiple procedures are done at one sitting, code them all
{{Ex|if a CT of chest, abdomen and pelvis is done, code them all}}
*For endoscopic inspection/explorations, code only the '''"furthest/deepest"''' area assessed.


=== No Procedures Performed ===
=== [[Aborted Procedure]] ===
If no procedures were performed '''enter [[No procedure performed]] as an [[Admit Procedure]] into the [[CCI Picklist]]''', the top of the tab. [[Check fundamentals for CCI]] uses this to make sure that entering procedures was not just forgotten.
*See [[Aborted Procedure]] for how to code


====[[Px Count]] with [[No procedure performed]]====
=== Repeated procedures ===
{{Discuss |  who = all | question =
If a procedure is done repeatedly '''on the same day''', only enter it once but count it in [[Px_Count]].  
Should we have [[Px Count]] restrictions when using [[No procedure performed]]? Having a requirement to make count = 0 would make even more certain that it was entered intentionally. Yet, requiring other than default entry would add marginally more work for collectors, and getting one more error might mean other errors are not read as thoroughly. Looking for input... Ttenbergen 15:21, 2018 September 27 (CDT)
}}


=== Procedures not coded ===
Procedures done on a '''different''' day should be entered again with a different date. This should be really quick by using the "duplicate" button.
See [[List of CCI procedures we don't code]]


==Data Integrity Checks ==
==Data Integrity Checks ==
{{#ask: [[Category:CCI Px check]]
{{Collapsable
|default=none found
| always= List of cross-checks
|format=UL
| full= {{#ask: [[DICSummary::+]] [[Category:CCI Px check]]
|limit=10
|?DICSummary = summary
|?DICStatus = implementation status
|sort=DICStatus, DICSummary
|default=No corresponding old article found
|format=broadtable
|limit=100
|link=all
|link=all
|headers=show}}
|headers=show}} }}


== Related Articles ==
== Related Articles ==
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== related literature ==
== related literature ==
[https://secure.cihi.ca/free_products/Coding%20standard_EN_web.pdf CIHI.ca coding standard CCI]
[https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf CIHI.ca coding standard CCI]






[[category: ICD10/CCI Conversion]]
[[category: ICD10/CCI Conversion]]
[[Category: CCI| *]]
[[Category:CCI| *]]
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